Professional jealousy

Switching from cigarettes to pharmaceutical nicotine products—that is, NRT—is standard practice in managing smoking cessation, but these products are not currently licensed for long term use as an alternative to smoking. Given that the risks associated with NRT are much lower than those associated with smoking, long term use of NRT products is a rational harm reduction strategy. However, as most smokers do not find the current NRT products to be as satisfying as cigarettes, the viability of these products as a long term substitute is limited. The technology to develop safe, inhaled forms of nicotine that could provide a more satisfactory alternative to cigarette smoking is available in the pharmaceutical industry, but in the context of the current regulatory framework in the United Kingdom and many other countries, such products would not be licensed and are therefore not commercially viable. As discussed above and in the previous article in this series, this imbalance in the regulation of nicotine needs to be redressed urgently in favour of public health.

Switching from cigarettes to pharmaceutical nicotine products-that is, NRT-is standard practice in managing smoking cessation, but these products are not currently licensed for long term use as an alternative to smoking. Given that the risks associated with NRT are much lower than those associated with smoking, long term use of NRT products is a rational harm reduction strategy.
However, as most smokers do not find the current NRT products to be as satisfying as cigarettes, the viability of these products as a long term substitute is limited. The technology to develop safe, inhaled forms of nicotine that could provide a more satisfactory alternative to cigarette smoking is available in the pharmaceutical industry, but in the context of the current regulatory framework in the United Kingdom and many other countries, such products would not be licensed and are therefore not commercially viable. As discussed above and in the previous article in this series, this imbalance in the regulation of nicotine needs to be redressed urgently in favour of public health.
Ann McNeill is an independent consultant in public health and an honorary senior lecturer in the psychology department at St George's Hospital Medical School, London. The ABC of smoking cessation is edited by John Britton, professor of epidemiology at the University of Nottingham in the division of epidemiology and public health at City Hospital, Nottingham. The series will be published as a book in the late spring.
Competing interests: Ann McNeill has received two honorariums and hospitality from manufacturers of tobacco dependence treatments. See first article in this series (24 January 2004) for the series editor's competing interests. BMJ 2004;328:885-7 Key points x Many smokers try to reduce the harm from smoking by cutting down or switching to "low tar" products x No evidence exists that cutting down or switching to low tar products substantially reduces health risks x Cutting down on cigarettes with concomitant use of NRT could be a more promising strategy x Switching to smokeless tobacco should substantially reduce adverse effects from tobacco use, but in many countries its use is illegal x Switching to pharmaceutical nicotine would substantially reduce harm, but NRT products are licensed as cessation aids, not as substitutes, and smokers tend to find them less satisfying than cigarettes x The regulatory framework in many countries, including Britain, discourages the development of nicotine products that are less harmful than cigarettes Further reading x

Professional jealousy
An Italian philosopher, Signor Ferriani, who has made extensive inquiries into what may be called the psychology of occupation, has constructed a scale showing the varying degrees in which professional jealousy exists in different professions. The lowest place in this scale is assigned to architects; next above them come clergymen, advocates, and military officers; then follow in order from below upwards, professors of science and literature, journalists, authors, doctors, and actors. It will be seen that our profession holds a bad eminence in the scale of jealousy, being marked as only a little lower than actors. According to Ferriani doctors display that mean vice by affecting to regard each other as quacks. The old saying, Invidia medicorum pessima, shows that doctors have long had an evil reputation in this respect. How is this to be accounted for? Ferriani thinks that the comparatively slight tendency to jealousy which he notes in architects and advocates is to be explained by "the precision and truth of their studies." From this remarkable pronouncement we are inclined to think that our philosopher himself belongs to one or other of those favoured professions. It would certainly not occur to many people, in this country at any rate, that the study of the law was in any special way marked either by precision or by truth. It may be admitted that barristers are, as a rule, less jealous of each other than doctors. The reason of this, however, is to be found not so much in the nature of their studies as in the fact that their personal feelings are but little engaged in the collisions which occur between them . . . But it is to be feared that in a profession in which men are necessarily brought into such close personal rivalry as is the case in medicine, jealousy, with its unhappy and often degrading consequences, is inevitable. There is no reason, however, why it should be so rampant. The remedy is that each of us should, by self-discipline and the pursuit of a high ideal of life, as far as possible subdue sordid commercial instincts, and look to the cultivation of a noble science and the practice of a beneficent art as in themselves our best reward. A man who is devoted to his profession for its own sake, and whose first consideration is not his own profit but the good of his patient, is not likely to be jealous of any one, and cannot be hurt by the envy, hatred, and uncharitableness of others. (BMJ 1904;i:151) Clinical review 887 BMJ VOLUME 328 10 APRIL 2004 bmj.com